Pain Without Lesion: Debate Among American Neurologists, 1850–1900
The central claim of this paper is that neurologists in mid-to-late nineteenth-century America generally denied the possibility that pain could exist in the absence of material lesion. There is ongoing debate over the medical status of pain sufferers in mid-to-late nineteenth-century America, with some arguing that what we might now term “chronic pain” became invisible during the period; others assert that physicians of the time were acutely aware of and sensitive to the suffering of their patients from a variety of pain experiences. Drawing on prior work related to the social and cultural efficacy produced in fin-de-siècle American culture by imaging the visible lesion, I argue that these apparently divergent views are both correct. On the one hand, there is little support in the primary sources for the idea that mid-to-late nineteenth-century American physicians ignored or trivialized the pain experiences of their patients. Indeed, given the Victorian emphasis on suffering and sympathy, such behaviour would have been especially taboo, at least with regards to socially privileged patients. On the other hand, the fact that American physicians of the time were aware of and sensitive to their patients’ pain does not imply that the physicians allowed that such pain could exist in the absence of a material (morbid) lesion. I contend that American neurologists followed their European counterparts in repeatedly insisting that if the patient experiences pain, then such a lesion must perforce exist, even if imaging techniques of the time simply did not permit discernment of the lesion itself. This finding has several implications. First, it fills a gap in the relevant literature inasmuch as there is little sustained historical analysis of the attitudes, practices, and beliefs of mid-to-late nineteenth-century American physicians regarding pain without lesion. Second, it contributes to the historiography demonstrating the power and significance that the increasing emphasis on discrete objects of disease had in mid-to-late nineteenth-century America. Third, it suggests some possible lessons for thinking about the continuing importance of the visible lesion in the widespread undertreatment of pain in the contemporary USA.
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